Obamacare survives -- now what?

It has now survived two near-death experiences. The Supreme Court could have struck down the law, but it didn’t. And with President Barack Obama in the White House for four more years, it’s not going to be repealed — or even gutted.

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Now it has to work. If it does, more Americans might come to accept it — and even be glad it passed.

If it doesn’t, Obama’s legacy will be tarnished. And Republicans will say “we told you so” for years to come.

Either way, Americans will now see what the law — the Affordable Care Act — is supposed to look like. The big pieces, including coverage of pre-existing conditions and the hated individual mandate, won’t kick in until 2014. Until now, all Americans have seen are the warm-up acts — like letting young adults stay on their parents’ plans — that aren’t really central to the law.

“We’ll have a real-world test of the Affordable Care Act and whether employers accept it, whether the public accepts it,” said Drew Altman, president and chief executive officer of the Kaiser Family Foundation. “That will change the entire discussion about the Affordable Care Act, because up to this point, it really hasn’t been a discussion of what the Affordable Care Act really does.”

Here’s what is supposed to happen in 2014: Everyone will be able to get health insurance, even if they have pre-existing conditions. Most people will have to be insured, unless they really can’t afford it. Subsidies will help many people pay. Every state will have a health “exchange” — a marketplace run by either the state or the feds or both — where people can get coverage if they don’t have it through the workplace or a government program like Medicare. Medicaid will expand to cover more low-income people.

What are the odds that everything will go according to plan? Pretty close to zero.

If the price of health coverage in the exchanges is too high, for example, conservative critics expect a backlash.“I think people will be in for serious rate shock, especially in those individual markets that have been relatively lightly regulated,” said Douglas Holtz-Eakin, president of the American Action Forum.

Democrats, however, are sticking with the theory they’ve had from the beginning: that Obamacare will become broadly accepted, and politically untouchable, once Americans experience the benefits. “Once people get the benefits, you can never take them away,” said longtime Democratic strategist Bob Shrum. “This will go well beyond a 50-50 issue.”

Here are some potential land mines to watch for over the next two years:

What else will opponents do to fight the law?

Republicans and other opponents aren’t just going to wave the white flag. They’ll still try to repeal parts of the law, ramp up investigations and target sections they see as legally vulnerable.

One fight already under way centers on whether people will be able to get subsidies in health exchanges that are run by the feds, or only when the states themselves run them. There’s also a pending legal challenge from Liberty University against the requirement that would make most businesses with more than 50 workers provide health coverage or pay a fine. Liberty says that requirement is unconstitutional — and yes, it has vowed to fight all the way to the Supreme Court.